| NPI | 1356681944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 101383) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 71826) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2021-06-16 |